Emily Nichols is The Fertility Guru. Through her website, Instagram and Facebook pages, she offers people well-researched and organized information about reproductive health. An acupuncturist, she blends Eastern and Western practices, giving readers a well-rounded look at how they can help themselves take charge of their reproductive health. And did I mention she’s funny? Well worth the read, click on the links below to learn more about The Fertility Guru:
I was drawn to your blog is because it is well-researched and well-written, and you present information in a humorous, relatable way. Fertility is clearly something you care about and want to educate others on-what motivated you to do so and to start your blog?
During my 3rd year internship at Pacific College of Oriental Medicine, just by a scheduling coincidence, I was placed under the women's health specialist at our clinic. The patients who came in for treatment on this particular shift tended to be women struggling with infertility. Treating these women came naturally to me, and, one after another, patients returned with positive pregnancy tests. Never had the rewards of treatment been so tangible.
Jump forward 7 years and most of the patients who come to my clinic have exhausted their western medical fertility options and are physically and emotionally fried. I've put in a lot of time studying the "typical" (and sometimes a-typical) western medical approach to infertility in order to understand the roller coaster ride these women go through before landing in my clinic. Besides treating the physical, I make sure to also treat the burnout I see with a side of humor and relatability.
My blog came about when I realized no one was talking about western and eastern approaches to fertility in the same space. They are constantly pit against each other, when in reality, both systems of medicine are describing the same body: western medicine sees the microscopic, while eastern medicine sees the broad interconnectedness of the body's systems. I thought, these two are not mutually exclusive. Why not combine the two theories of medicine in one place, using a relatable, causal and relevant style of writing? My goal was to relay sourced information in an approachable way.
How much of your advice is East vs West? Or is it an even split?
I try to split my advice down the middle. I want my audience to see the benefits and shortcomings of both, and how, when combined, they connect all pieces of the puzzle together. Most women coming to my blog are not new to fertility challenges and have done a lot of research on the western approach: how their cycles work, the hormones involved, their lab numbers etc.... But eastern medicine is a completely foreign concept. I lay out eastern theory in its most simplified form in order to encourage an understanding of the fundamentals and how one might view the body through a slightly different lens.
You are an acupuncturist. Do you primarily treat women’s health issues? What kind of success have you found in treating fertility issues with acupuncture? Can you give a brief synopsis on what to expect when someone comes to see you to treat their fertility issues?
Yes I run a fertility-specific clinic here in San Diego, called Green Gardens Fertility Acupuncture, where I treat both women and men for reproductive issues. I mostly see fertility cases but I also treat pregnancy and postpartum, as well as menstrual and menopausal pathologies.
Treatment using eastern medicine is based on the individual and not designed to fit a certain western diagnosis, so each patient is treated differently. However, a 37 year old women diagnosed with unexplained infertility can expect to receive treatment every week for six menstrual cycles. A strict herbal regimen is recommended and compliance is a must. Herbs taste awful but are so powerful and such a key component of successful results. Treatment also includes diet and lifestyle recommendations, bodywork, stress reduction protocols, and other eastern modalities including cupping and moxibustion.
I find that there is a lot of shame surrounding fertility and all the issues that come with it when people struggle to build their family. I think your blog is an amazing space that normalizes the experience and helps people know what they can expect to encounter and what they can possibly to do to help themselves. With that in mind, what post would you first direct people to if they are feeling overwhelmed by it all and are searching for information?
Great question! I would point those feeling overwhelmed to read my post: Come Together Right Now Over Me: Finding Your Support Group.
In it I write, "Dealing with infertility can be isolating. Emotions run high as frustration and grief intertwine. Discussing infertility is still bound up in social stigmas. And since it's commonplace these days to look at the world through the rose colored glasses of social media, we often push our emotions down, put on a brave face and act as if everything is A-OK (insert the thumbs up emoji!) But emotional isolation can be hugely damaging. It is so important to find a community that listens to your story, understands your needs, and supports your efforts to build a family. Luckily there are so many great support groups and bloggers speaking up, talking about the realities of their fertility journey, and validating the emotional response to the crisis of infertility."
I go on to list great support resources that I feel fit well with the goals and style of my blog. The communities are genuine, uplifting, funny and not afraid to talk about the emotional truths of infertility. Its important to feel like you are not alone in your suffering and to find strength together in a community.
What are your thoughts on the mind/body connection?
In eastern medicine the mind and the body are intimately connected. Think of the mind as a projector. Emotions are, synaptically speaking, created in the brain. But in eastern medical theory, the mind then projects a map of those emotions onto the systems of the body. A thousand years of medical observation has deduced, for example, that sadness projects onto the Lungs. That's why we find that people with depression tend to have weak immune systems and are prone to cough and cold. Its also observed in Chinese medicine that stress projects onto the muscles and tendons. That's why when you've had a hard day at work your neck and shoulders ache. Similarly, if you've just gone through a break up you feel heartbreak in the area of your actual Heart, even though western medicine describes the function of the heart as having nothing to do with processing emotions. The theory that the mind and its emotions are intertwined with the body's physiology is at the root of eastern medicine and critical in treating the patient as a whole.
Which of your posts seemed to affect people the most?
The post that got the most attention was But Seriously, How Does Acupuncture Work? : Eastern Medical Theory 101. I think people are really curious to understand how inserting needles has help so many people. The post breaks down the theoretical fundamentals behind eastern medical theory in terms that are easy to understand and relate to- nothing too heady or mystical. Check it out!
* My second best post was on coffee and how research has shown a reduction of caffeine can increase your chances of pregnancy. Boy was that a topic people had an opinion on!
What advice would you give to someone about to start the journey of fertility treatments, Eastern or Western or both?
My advice to someone struggling with fertility and looking for answers is be proactive in your pursuit. So often we feel helpless because we let the advice of doctors and specialists stagnate our self understanding. Navigating through the day with fertility on your mind can be overwhelming. Use the O.E.E method. O: Organize your thoughts daily (You can use TFG's Fertility Planner as a checklist in order to organize your daily must-do's.) E: Exercise to move stuck Qi and make your body feel physically good. E: Educate. Continue learning to become your own fertility guru. These tools will empower you and help navigate through your own successful fertility journey.
Mary Ellen Kramp, DPT, CLT-LANA is a Physical Therapy Specialist in Seminole, Florida. Her professional experience includes 25 years providing care in a variety of inpatient rehab and outpatient settings. She is the owner of Relief at Hand, LLC, a small manual therapy clinic that maintains an integrative practice of physical therapy, massage therapy and acupuncture. In the past ten years she has become more specialized in women’s health areas including post-breast cancer lymphedema and infertility. Currently, she is leading a multi-site pilot study focused on manual therapy for women’s infertility.
Please read more about Dr. Kramp, and her work and her study at:
What motivated you to focus your career on women's health and infertility?
I had worked in Michigan several years ago, and had the reputation for being able to treat any weird kind of thing. If you had a patient with weird issues, send them to me. My best friend was trying to get pregnant, and at one point (after I had moved to Florida) called me and asked for my help. Using the same principles that we would use for the shoulder joint, I applied it to the reproductive system. She went home, and got pregnant. A couple years later, she had gotten pregnant and miscarried, and then couldn't get pregnant again. I treated her again and she got pregnant immediately. I knew then that we needed to do the scientific research and show that this is a viable option for people struggling with infertility.
You are currently working on a research study entitled: Physical Therapy For The Treatment Of Infertility. Can you tell me more about it?
We are recruiting 30 women at this point in time. It's a pilot study. We want to work out all the kinks before we go into the large study that we’ll be doing. In the large study, we're going to have about 25 to 30 sites nationwide, and right now we have five sites. Currently, it's a randomized control trial. The participants are blinded as to which group they're in. Since no physical therapy type treatments have been studied, as far as efficacy of physical therapy for infertility, we chose one other type of treatment and we're comparing the two treatments, as far as effectiveness. We have the main treatments and then we have another set of treatments
that are being done in the control group. The women are seen weekly for the first four weeks, and then after their next period, we see them between their period and ovulation for that cycle. Then if they get their period again, after that period and between ovulation, for the sixth treatment. We follow them up for three cycles to see if and when they do become pregnant after they finish the six treatments. Those are the main things. Women that were in the control group (because we're hypothesizing that in the control group they won't be quite as successful as the treatment group) will be offered the treatments at the end of the study. There's no charge for any of the treatments.
Who would be a good candidate?
We do not know for sure yet who would be the optimal candidate, because we are just starting the research. We are planning to assess all women struggling with fertility, because we may be surprised that some diagnoses may be responsive to our treatments that we did not think would be. For our research, the only women we are not accepting are those who do not have a normal reproductive tract, who have had prior tubal ligations and reversals, and who have cancer. We are hypothesizing that the optimal candidate would be those who has been through all of the testing. Doctors have checked hormone levels and their cause is still unknown. Hormone levels are okay and the tubes are open and everything seems to be fine. They would be optimal, because it’s possible they have physical restrictions that might be preventing pregnancy.
Can you tell me a little bit about how physical therapy treats infertility?
Looking at the reproductive system, if we compare it to a shoulder, you have the bones of the pelvis, just like you would have the bones of the shoulder. You have ligaments holding the pelvis together. You also have the uterus in there, and the fallopian tubes, and the ovaries and bladder, et cetera, et cetera. Well, you have ligaments holding that uterus to the front of the pelvis, you have ligaments holding it to the back of the pelvis, to the sides. The blood vessels travel through all that connective tissue that is surrounding and supporting the uterus and the tubes and the ovaries. If there is tension in those ligaments, there is going to be probably some compromise in the blood getting to and from the uterus itself. So, can the uterus get what it needs? Can the ovaries get what they need if there is compromised circulation in there? Looking at it from a physical standpoint, sometimes you can have a pretty harsh environment for the reproductive system. What we're trying to do is optimize and normalize everything so you have
this nice, friendly environment, an optimal environment for the ovary to be able to produce its eggs, for the tubes to be wide open, for the uterus to create the endometrial lining, and be a hospitable environment for implantation and to support a pregnancy.
What should one expect in a visit to your office?
When a woman comes in, I assess her pelvis, just like if she was coming in to me for low-back pain. I check to see if her pelvis is even. I assess her lymphatic system, to make sure that is open. I check for trigger points in the muscles around the pelvis and then I check the ligament mobility around the uterus to see how mobile that is. Then I will do a vaginal exam and check and see how the pelvic floor is. I will also check the mobility of the cervix, because studies have also shown that mobility of the cervix is important, as well. That's the typical evaluation.
What can someone expect to feel in general during treatments or afterward?
For the most part, it's very, very gentle. The techniques are much lighter than you think they would be because I'm just basically acting as a catalyst to get the body to react. I am putting some tension on those ligaments, just enough so I am engaging them, and then putting them in a position where the body must respond. People usually don't feel a whole lot during the treatment. They'll feel it when I hit a trigger point, but I bring the body to a position around the trigger point where I'm basically hugging the trigger point, and allowing the body to neurologically shut off the spasm that's happening in that section of muscle. It's a similar type of technique for the connective tissue and ligaments. The lymphatic drainage feels more like a massage, so it's a pretty comfortable treatment. Afterward, some women can have some spotting, there might be a little bit of cramping, there might be some low-back discomfort, the muscles might be a little sore, because when tissues are really tight for a long time, the blood flow isn't quite as good through the area as it should be, and the waste process from the normal cell metabolisms build up. So, it allows the body to release all of that back into the blood stream. The body picks that up, and so there's a general achy, soreness, it feels like you worked out too much type thing. Then within 24 to 48 hours, the body has cleared all that out and the person feels fine. In general, most women feel just more comfortable.
At what point in their infertility journey would you say they should start seeking treatment in the physical therapy form?
I would like to see them when they notice that they're struggling. I would like to see physical therapy as a first-line treatment. Before somebody spends over $10,000 in treatments, I would prefer they spend a tiny little amount (1% of that $10,000) in physical therapy to see if it makes a difference for them. Even if it doesn't, there could be other combined factors that PT can address. I would like to treat these women prior to IVF, and see if we can up the success rates of IVF, too.
Do you do physical therapy in conjunction with other medical treatments, or is it one or the other?
I’ve worked with some women while they've been on Clomid or I've treated them and they're going for an IUI, or I've had a couple that have asked me if I could treat them before they go for an IVF treatment. I also have an acupuncturist in my office and we'll often co-treat during a session.
In general, what kind of success have you seen with your infertility patients?
About 60%. I see women typically between one and six visits and within three months after finishing the last visit, it's about a 60% success rate, which the average couple trying. When the average couple begins to try to conceive, within three months, 57% of them will become pregnant, at six months 75% will become pregnant, and at a year 85%. We're bringing it up to normal rates of fertility.
What is your favorite thing about working with your patients?
I love seeing the changes that happen, even in the cases where someone wasn't able to become pregnant. They tend to have more comfortable periods, they tend to have more regular periods. I have had several patients tell me, "Oh my gosh, I didn't realize I was having pain with intercourse until after you treated me. I didn't realize how good sex could feel." There are a lot of benefits on top of the fertility that these women achieve during the sessions. I just love seeing people being able to function better. Even if a pregnancy is not achieved (which is the coolest thing in the world when it does happen), I just love being able to impact parts of their lives that are so private, that they don't talk to their friends about. I love being able to give somebody a better sex life, I love being able to take their pain away with periods, that they didn't know could ever be done. I can't express how rewarding that is.
Is treating infertility with physical therapy a new concept?
Yes, it’s new. We are just starting to do the research on this. My thought is, I want to show that this is something that is viable and I want to teach it to any therapist who wants to learn it, because I think it should be out there for everybody.
How can somebody seek you out to join your research study?
They can visit us at www.mechanicalinfertilitystudy.com and www.pelvichealthresearch.org.
Dr. Christina Prieto is a Board Certified and Licensed Acupuncture Physician and owner of Harmony Wellness Center in Maitland, Florida. A Florida native, she studied at the Florida College of Integrative Medicine, graduating Cum Laude with a Bachelor’s Degree of Science in Professional Health Studies and a Masters of Science in Oriental Medicine. These studies include specialized training in acupuncture, Chinese and western herbs, nutritional therapy, cupping, moxibustion, and other modalities.
Please read more about Dr. Prieto, her experience, expertise and adventures here: http://christinaprieto.com/acupuncture/
fertility page: http://www.harmonywellnesscenter.com/acupuncture-for-fertility-orlando/
youtube video about Dr. Prieto’s practice:
How does acupuncture help treat infertility?
There are two major ways acupuncture can treat infertility. One is by calming the nervous system and the other is by increasing blood flow into the reproductive organs. I often tell my patients that the acupuncture tricks the body into thinking you’re on a remote beach overlooking the sunset. Many studies show that when blood is drawn before and after an acupuncture treatment, there is a physiological response on a chemical level, such as: a release of endorphins and neurotransmitters; anti-inflammatory components; and hormone fluctuations. This reaction is what promotes healing in the body.
Who is a good candidate for acupuncture for infertility?
Anyone who is open to integrating acupuncture into their fertility journey is a candidate. I see patients who range from a completely natural approach to those who are undergoing invasive IVF protocols. The beauty of acupuncture is that there is no outside factors other than what your body is capable of doing on its own, so everyone is a candidate.
At what point in someone’s infertility journey should they begin acupuncture?
Ideally, it’s great to start acupuncture as soon as possible in the journey. When patients are gearing up for IVF or IUI, I recommend they start 3 months before the onset of their treatment plan. This helps the body achieve the best possible state so that the patient can better respond to their fertility treatment.
What are your thoughts on the mind/body connection regarding infertility?
The mind and body connection is the missing link in conventional medical approaches, in my opinion. Not only with infertility, but with every disease that exists. I believe that imbalances in our physical body aren’t random, rather they are a reflection of all the things we’ve experienced in life from emotional traumas, to the unhealthy things we’ve eaten, to our spiritual beliefs, and beyond. That’s quite a large statement but according to Chinese medicine, every emotion, every food, and even our living environment, is associated with a particular organ system in the body and can either help or harm the body’s inner harmony.
Do you suggest supplements as part of your protocol (I recall taking royal jelly)?
YES! I am a huge fan of royal jelly. Did you know that a queen bee’s sole function is to be the reproducer of all the bees in her hive? See, in Chinese medicine we aren’t too concerned with calories or carb counting-we look at the nature of the food, where it comes from and how it relates to the body. Seeds, nuts and eggs are also popular fertility foods because all of those things have the potential for expansion and new life.
Is there anything else you recommend to complement a patient’s treatment?
Meditation, prayer, counseling, journaling, moderate exercise, positive affirmations, gentle yoga, dietary changes, and lots of self-care! Not necessarily in that order.
Is acupuncture often used in conjunction with medical treatments?
More often than not, actually.
How many of your patients use acupuncture in addition to medical treatments?
I would say 70% of my fertility patients are also undergoing some kind of conventional medical treatment.
Can patients find success with only acupuncture (and no medical treatments)?
Often I have patients that are not ready to go the conventional route, for a multitude of reasons. Gratefully and humbly, I can say that a large number of couples have conceived by just integrating the acupuncture treatments and being compliant with other lifestyle, diet, and herbal recommendations.
Do you treat men for infertility?
Yes. I often say that men are “easier to fix” because their anatomy is a bit less complicated than the female. Although it's less common for me to see a male for infertility, I’ve had many male factor infertility patients get amazing results. I had one patient with zero live sperm in his sample. His second sample had 1 live sperm and then he went up from there into hundreds, He eventually was able to be a candidate for IVF with ICSI. They have beautiful twin girls.
Can you describe a typical visit for someone seeking acupuncture for infertility?
First, we sit down together and do a full intake where I ask about one hundred questions regarding their fertility, digestion, sleep, diet, mood, energy level, and a bunch of other health-related questions. At this point I gather enough information to make a diagnosis, treatment plan, herbal, and dietary recommendations and so on. Also, the patient usually has questions that we can address. If they choose to do the treatment, I generally recommend that they come in at a certain time in the cycle where it’s optimal to have a session, generally this is 4 times per cycle.
What kind of success have you seen working with infertility patients?
At one point in my career I tried to keep statistics, but I soon realized there were just too many factors to be able to have solid conclusions. I have so many different types of cases, age ranges, and levels of compliance, so it was impossible to log the patient results without going back to college for another degree, ha! I would say that the success is high enough to keep testimonials rolling in on a regular basis. If I had to guess, I would say 1 out of 3 patients who are compliant and consistent with treatments will end up pregnant.
What do you wish all your patients knew before coming to an appointment?
More than anything, I wish they knew they aren’t alone. I can treat up to 3 patients at one time and quite often, I have 3 women undergoing infertility treatments just one wall apart. I wish my patients knew that they aren’t broken, that their body is truly trying to run optimally. I wish my patients knew that this is a process and that it may take time, but that they have the potential to produce the miracle of new life. And that every time they show up for a treatment and will find themselves laying alone in a dim, quiet room, with their beautiful and capable bodies, that it’s a chance to love themselves exactly how they are.
What are the top three most frequently asked questions you hear from fertility patients? What are your answers?
1. How often should I come? Once weekly or 4 times per cycle.
2. Does my insurance cover treatments? Every policy is different. Some of my patients have great coverage, others do not.
3. Is this going to hurt? No. There is a sensation associated with acupuncture, but it’s not pain. It can vary from no sensation whatsoever to an electric current. But if anything “hurts,” I can adjust the needle or select a different point, no biggie!
What is your favorite thing about working with your patients?
It never feels like work. I would argue that I have the most rewarding job on the planet because I get to work together with my patients to achieve something that is the ultimate miracle: a baby. When I get a photo in my email inbox, or a birth announcement in the mail, my heart overflows and I know that I’ve found my calling.